Sight translation by Mary Luczki.
The healthcare system can be difficult to navigate for anyone, however, there are even more barriers to navigating and understanding the healthcare system and its resources when a patient isn’t a native English speaker and/or not a member of the dominant culture. Fortunately there is a growing presence of Community Healthcare Workers (CHW) helping patients coordinate the care and services they need. CHWs provide outreach, health education, care coordination and advocacy for underserved patients of all ages.
Who is a Community Healthcare Worker (CHW)?
CHWs come from the communities they serve because they have an intimate understanding and relationship with their patients; their native use of the language and first hand participation in the cultural norms and traditions give them a perspective of which medical providers, and in some cases, interpreters, do not have.
What do CHWs do?
CHWs fulfill several roles including:
- outreach worker
- care coordinator
CHWs are able to identify at risk patients who may struggle to find and receive necessary medical care and social programs. Once a patient is identified, a CHW can partner with them to fulfill any of the roles outlined above. One of the critical goals of CHWs is to help patients reduce unnecessary ER visits by increasing health care literacy and competency.
What are the benefits to using CHWs?
- Reduce no-show rate
- Minimize errors resulting in clinical consequences
- Increase patient compliance through home visits under a provider’s care plan
- Increase health knowledge through reinforcement education
- Increase patient focus during office visit
- Increase patient ability to participate in his/her healthcare
CHWs and the Deaf Community
While CHWs are becoming more prevalent on medical care teams across the country, Deaf CHWs are still emerging. Since a great deal of medical information is not readily available in American Sign Language (ASL), a CHW can play a critical role in healthcare literacy. While an interpreter is necessary at every medical encounter involving a Deaf person, it sometimes takes the addition of a CHW to ensure comprehension and participation in the proposed healthcare plan. CHWs are a great resource for Deaf patients, medical providers, and interpreters, however, all Deaf patients are different and not every Deaf patient will need/want a CHW. It’s important to communicate with the patient, medical team and interpreter to best determine the need for a CHW.
Minnesota is the leader in Deaf CHWs and is leading the way for other states as they work to standardize the training of Deaf CHWs. In Minnesota, a Deaf CHW is required to complete a 14 credit, curriculum based training program so that they can best leverage their intimate understanding of Deaf people and ASL with the necessary tools to be most effective on the medical team.
CHW and Interpreters
Interpreters are able to communicate with patients and advocate for communication access, however, their scope of work limits them to just that. CHWs can work with the interpreter to ensure patient comprehension resulting in improved healthcare outcomes. It is important to note that CHWs are Deaf but not Deaf interpreters and are not a suitable substitution for certified hearing and Deaf interpreters.
It is clear the benefit of using a CHW, but funding them can be a barrier for medical facilities. Funding for CHWs can come from a variety of sources:
- Government grants and contracts
- Foundation grants
- General operating dollars
Currently, Minnesota and Alaska receive funding from Medicaid to pay for CHWs. Government grants and programs are often how CHWs are funded across the United States and it is up to medical facilities to locate and apply for the grants. Unfortunately, there is not a centralized list or governmental office that outlines all the financial resources available for CHW funding.
Limited English patients, Deaf patients and patients who may be identified as “at risk” can greatly benefit from a CHW as they navigate the healthcare and social services system. The addition of a CHW to the patient’s medical team early on can help medical facilities and providers save substantial time and money in the long run but most importantly, CHWs help patients get and stay on the road to health and wellness.